Please refer to the Resident Selection Plan: https://www.cmc-nc.com/complex/google/complex.php For Office Use Only: (date/time): / am / pm by (initial): HH ID # APPLICATION FOR LEASE OF APARTMENT EQUAL HOUSING OPPORTUNITY Brookridge Apartments 3930 Durham Drive, Raleigh, NC 27603-3700 (919) 779-9450 (919) 779-9520 Phone Fax INSTRUCTIONS: YOU MUST ANSWER ALL QUESTIONS IN FULL. DO NOT LEAVE ANY SPACES BLANK; WRITE NONE WHERE APPROPRIATE. COPIES OF DOCUMENTS LISTED ON PAGE 6 MUST BE ATTACHED. APARTMENT SIZE DESIRED. Check any that apply (NOTE: All unit sizes may not be available at this property). 0-Bdrm 1-Bdrm 2-Bdrm 3-Bdrm 4-Bdrm 5-Bdrm HEAD OF HOUSEHOLD INFORMATION: FIRST NAME MI LAST NAME SOCIAL SECURITY # DATE OF BIRTH AGE PREVIOUS OR MAIDEN NAME DRIVER S LICENSE # / STATE STUDENT STATUS Full-Time Part Time No HOW DID YOU HEAR ABOUT THIS APARTMENT COMMUNITY? Do you expect to be a student in the next 12 months? MARITAL STATUS: Single, Never Married Married Separated Widowed Divorced Other OTHER HOUSEHOLD MEMBERS: (List all other persons who will live in the unit 50% or more of the time in the upcoming 12-month period, including unborn children.) No person is to live with you who is not listed. Attach additional pages if needed. NAME RELATIONSHIP TO HEAD OF HOUSEHOLD FULL TIME* STUDENT STATUS (check one) PART TIME NOT A STUDENT SOCIAL SECURITY # DATE OF BIRTH MARITAL STATUS * Full-time student: Any individual who currently is or will be enrolled at an educational institution with regular facilities during 5 calendar months for the number of hours or courses that are considered full-time attendance by that institution. The 5 months need not be consecutive. MAILING ADDRESS: Street City State Zip DAYTIME PHONE # CELL PHONE #: EMAIL ADDRESS: EMERGENCY CONTACT: NAME RELATIONSHIP PHONE # M:\PROPMGMT\APPLICAT\FORMS\APPLICATION TC rev 6.30.2017.doc Page 1 of 6
RESIDENTIAL HISTORY: MINIMUM 3 CONSECUTIVE YEARS REQUIRED! Attach additional pages if needed. CURRENT ADDRESS STREET ADDRESS CITY COUNTY STATE ZIP DATES / / TO / /. LANDLORD S NAME RELATIVE? YES NO MONTHLY RENT or MORTGAGE LANDLORD S ADDRESS MONTHLY UTILITIES REASON FOR MOVING LANDLORD S PHONE NUMBER PREVIOUS ADDRESS STREET ADDRESS CITY COUNTY STATE ZIP DATES / / TO / /. LANDLORD S NAME RELATIVE? YES NO MONTHLY RENT or MORTGAGE LANDLORD S ADDRESS MONTHLY UTILITIES REASON FOR MOVING LANDLORD S PHONE NUMBER PREVIOUS ADDRESS STREET ADDRESS CITY COUNTY STATE ZIP DATES / / TO / /. LANDLORD S NAME RELATIVE? YES NO MONTHLY RENT or MORTGAGE LANDLORD S ADDRESS MONTHLY UTILITIES REASON FOR MOVING LANDLORD S PHONE NUMBER HOUSEHOLD INFORMATION. You must explain in the space below, any questions answered YES. Do you anticipate any changes to your household during the next twelve (12) months? Are there any absent household members who normally live with you? Do you anticipate any household member becoming a full-time student* in the next twelve (12) months? * Full-time student: Any individual who currently is or will be enrolled at an educational institution with regular facilities during 5 calendar months for the number of hours or courses that are considered full-time attendance by that institution. The 5 months need not be consecutive. Have you or any members of your household ever had your lease terminated or ever been evicted? Are you relocating from a property professionally managed by Community Management Corporation (CMC)? Community Name? Are you or any members of your household receiving rental assistance (voucher, public housing, etc.)? Are you currently fleeing from an abusive situation? Are you or any members of your household subject to a State lifetime sex offender registration? Do you currently own a pet? (Note: pets are not permitted at some properties. Please ask the manager for details.) M:\PROPMGMT\APPLICAT\FORMS\APPLICATION TC rev 6.30.2017.doc Page 2 of 6
ASSET LIST. Do you or any household members have any of the following assets? CASH on hand or held in safety deposit box/home Checking Accounts Savings Accounts Depository Debit Card (i.e, for child support or social security) Certificates of Deposit (CD) or Money Market Funds Stocks, Bonds or Securities IRA / Keogh Account /401(k) / Retirement Accounts / Pension Funds Mutual Funds Treasury Bills Trusts If yes, is the trust non-revocable? Real Estate (Land, Homes, Rental Property, etc.) Whole life or universal life insurance policy Assets held in another state or foreign country Personal Property Held As Investment Mortgage held by (not being paid by) household (i.e., contract sale) Inheritance, Capital Gains Lottery winnings Insurance Settlements Other Assets (Describe): ASSET DETAILS. Detail ALL assets for ALL household members marked Yes above. Bank Accounts / Depository Debit Card HOUSEHOLD MEMBER NAME NAME OF BANK ACCOUNT TYPE CURRENT BALANCE Real Estate HOUSEHOLD MEMBER NAME SOURCE/TYPE VALUE CURRENT MORTGAGE BALANCE MONTHLY MORTGAGE PAYMENT WHO HOLDS THE MORTGAGE? WHO PAYS THE MORTGAGE? MONTHLY RENTAL INCOME Other Assets HOUSEHOLD MEMBER NAME SOURCE/TYPE VALUE ASSET DISPOSAL. Have you or any household member disposed of any asset for less than fair market value within the last 2 years? YES NO If yes, please list: TYPE OF ASSET DATE OF DISPOSITION AMOUNT RECEIVED MARKET VALUE TYPE OF ASSET DATE OF DISPOSITION AMOUNT RECEIVED MARKET VALUE M:\PROPMGMT\APPLICAT\FORMS\APPLICATION TC rev 6.30.2017.doc Page 3 of 6
INCOME LIST. Do you or any members of your household receive income from any of the following sources? Wages/salaries Tips, fees, bonuses or commissions Overtime pay Business/Self Employment Military Pay Unemployment benefits Worker's Compensation Severance Pay Social Security / SSI Public Assistance / TANF Alimony Child Support (check YES for any received and/or court-ordered amounts) Income from rent or sale of property Recurring monetary gifts or noncash contributions Student financial aid, educational grants/scholarships Periodic payments from: Disability Benefits (other than SSI) Death Benefits Retirement Funds / Pensions Annuities or non-revocable trust Insurance Policies Lottery winnings Other Income: If any adult is currently unemployed or has lost a job within the last 12 months, please provide prior job information. If none, please write NONE. Termination of jobs within the last 12 months will be verified. HOUSEHOLD MEMBER NAME PREVIOUS EMPLOYER NAME, ADDRESS & PHONE # DATE TERMINATED INCOME DETAILS. List each source of income for all household members. Use GROSS ANNUAL AMOUNTS (before deductions). Income/amounts from all sources will be verified. HOUSEHOLD MEMBER NAME INCOME SOURCE/TYPE (I.E., WAGES, SSI) EMPLOYER/PROVIDER ADDRESS & PHONE # ANNUAL GROSS AMOUNT Did you or any household members file a federal tax return last year? Yes No M:\PROPMGMT\APPLICAT\FORMS\APPLICATION TC rev 6.30.2017.doc Page 4 of 6
CRIMINAL HISTORY Have you or any members of your household been arrested for or convicted of any crimes listed below? YES NO If yes, indicate by using numbers below. 4. THREATS OR HARASSMENT 9. PUBLIC INTOX./DRUNK AND DISORDERLY 5. DESTRUCT. OF PROP./VANDALISM 10. RECEIVING STOLEN GOODS 1. HOMICIDE/MURDER 6. ASSAULT OR FIGHTING 11. FRAUD 2. RAPE OR CHILD MOLESTING 7. DRUG TRAFFICKING/USE/POSSESSION 12. PROSTITUTION 3. BURGLARY/ROBBERY/LARCENY 8. CHILD ABUSE/DOMESTIC VIOLENCE 13. DISORDERLY CONDUCT MEMBER S NAME CRIME(S) # STATUS/DISPOSITION MEMBER S NAME CRIME(S) # STATUS/DISPOSITION SPECIAL UNIT REQUIREMENT(S) QUESTIONNAIRE (If not applicable, please write in NONE ) Do you or any members of your household have a condition that requires: A Separate Bedroom Unit for Vision-Impaired A Barrier-Free Apartment Unit for Hearing-Impaired Physical Modifications to a Typical Apartment Any Other Accommodation If you checked any of the above listed categories of units, please explain exactly what you need to accommodate your situation: Who should be contacted to verify your need for the features you have identified above? NAME PHONE ADDRESS AUTOMOBILES. This information is necessary to keep a record of vehicles allowed on the premises and to control adequate parking. MAKE MODEL COLOR YEAR LICENSE TAG NO./STATE REGISTERED OWNER MAKE MODEL COLOR YEAR LICENSE TAG NO./STATE REGISTERED OWNER M:\PROPMGMT\APPLICAT\FORMS\APPLICATION TC rev 6.30.2017.doc Page 5 of 6
SIGNATURES THE APPLICATION MUST BE SIGNED BY ALL ADULT MEMBERS OF THE HOUSEHOLD. BY SIGNING BELOW, APPLICANT(S) AUTHORIZE MANAGEMENT TO VERIFY THE REPUTATION AND CHARACTER OF ALL HOUSEHOLD MEMBERS VIA REFERENCES, LAW ENFORCEMENT AGENCIES, CREDIT BUREAUS, AND CURRENT/PREVIOUS LANDLORDS. (SEE ATTACHED FEDERAL FAIR CREDIT REPORTING ACT DISCLOSURE.) APPLICANT(S) HEREBY CERTIFY THAT THE INFORMATION PROVIDED IN THIS APPLICATION IS TRUE, CORRECT AND COMPLETE AND THAT ALL INCOME AND ASSETS OF THE HOUSEHOLD ARE LISTED. APPLICANT(S) UNDERSTAND AND AGREE THAT THE OWNER IS REQUIRED TO VERIFY THIS INFORMATION AND AGREES TO SIGN ALL AUTHORIZATIONS FOR RELEASE OF INFORMATION NEEDED TO VERIFY THE INFORMATION PROVIDED. SIGNATURE: (APPLICANT) DATE: PENALTIES FOR FALSE OR WILLFULLY OMITTED INFORMATION INCLUDE REJECTION OF APPLICATION AND/OR EVICTION. EQUAL HOUSING OPPORTUNITY *PLEASE BRING WITH YOU OR ATTACH TO THIS APPLICATION COPIES OF: 1. BIRTH CERTIFICATE OR DRIVERS LICENSE FOR ALL ADULTS IN HOUSEHOLD. 2. BIRTH CERTIFICATE FOR ALL MINOR HOUSEHOLD MEMBERS 3. SOCIAL SECURITY CARD FOR ALL HOUSEHOLD MEMBERS. *THIS APPLICATION CAN NOT BE PROCESSED UNLESS ALL INFORMATION IS COMPLETE. Please refer to the Resident Selection Plan at: https://www.cmc-nc.com/complex/google/complex.php or a printed copy will be provided upon request. FEDERAL FAIR CREDIT REPORTING ACT DISCLOSURE You are hereby notified that Brookridge Apartments may obtain a consumer report or an investigative consumer report during the processing of your application for an apartment. These reports will be obtained from public or private record sources or through personal interviews with your neighbors, associates, friends or prior Landlords for the purpose of evaluating your ability to meet the Tenant Selection Criteria established for the property. These reports may contain information bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living. Such reports will only be obtained after receipt of your written consent to obtain the information. Your signature of the rental application will serve as such authorization. M:\PROPMGMT\APPLICAT\FORMS\APPLICATION TC rev 6.30.2017.doc Page 6 of 6